| NPI | 1659065217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11027126) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9540425) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11027019) | |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2023-12-26 |